Question
QUESTION: Seven months ago I went to a chiropractor for the first time because I was experiencing so low back pain and sciatica symptoms in my calf, he performed side posture adjustments on me which have left me in a great deal of pain, I have seen back specialists and orthopedic doctors and they keep telling me he flared up one of my disks so I went to another dc hoping he could help me so he performed more adjustments which once again have sent me reeling in pain now my doctor says the pain is coming from my si joint, they have done an si joint injection which confirmed the diagnosis but did not help the pain. Is it possible the first dc damaged my si joint? If not why am I experiencing so much pain after the adjustments and for 7 months that won't go away, I am receiving physical therapy and astym but am not getting much relief.

ANSWER: Thanks for your question.

First, it is possible for manipulation to aggravate an acutely inflamed disc, usually by causing more inflammation to the area. It is far more difficult for manipulation to actually cause a disc herniation.

Secondly, it would be difficult to injure the sacro-iliac joint through manipulation, although it is, I suppose, possible if enough force were imparted. The sacro-iliac joint is the largest joint in the body, and I would think that a sprain of the ligaments might be a more possible undesirable effect of manipulation.

It sounds like you have two separate problems going on; a lumbar disc herniation and a sacro-iliac joint sprain.

The disc herniation can be managed with anti-inflammatory medication and analgesic medication. Epidural injections may also help to reduce the inflammation around the disc causing pain. If you are not getting relief with pain medication and physical therapy, you probably should have an MRI performed. Some patients who have significant degenerative changes (arthritis) in the spine also develop cysts (called synovial cysts or neural cysts) in and around the nerve roots which can mimic the signs and symptoms of a disc herniation; this needs to be removed surgically to get rid of the pain (which usually presents like sciatica-type pain). An MRI would also be able to quantify the extent and severity of the disc herniation.

Steroid injections (to reduce inflammation) also can treat the sacro-iliac joint pain.

Patients who suffer from sacro-iliac pain, especially if there is a sprain, often benefit from a sacro-iliac brace. Much like a lumbo-sacral support belt (but worn lower), an S.I. joint brace helps to stabilize the pelvis, reducing pain. A simple test to determine if the S.I. joint is the primary pain generator is to sit straight in a chair with your feet flat on the floor. Without bending forward, stand up from the seated position. If you have significant pain more in the S.I. joint than in the lower back as you stand, then the S.I. joint is probably the primary problem. Repeating the test with the S.I. brace on should allow you to stand up with far less pain in S.I. joints. You can purchase an S.I. brace on the Internet or at a good medical supply store.

I also recommend the book, "Treat Your Own Back", by the Australian physiotherapsit Robin McKenzie. It is available on the Internet or through a book store.

I hope that this helps to answer your question.

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QUESTION: Thank your for your response, I have had an mri which shows a small bulging disk at l5 but the doctors say is is not impinging the nerve so it's highly unlikely its the source of my pain, I have had one si joint injection which did give me pain relief for a few hours, I am scheduled for a second injection on thursday. How long does it take for a si joint sprain to heal? I am wearing a brace now, how long do you recommend wearing the brace? Is there any other advice you can give me on healing myself quicker? Thanks so much for you help, I have been so frustrated with being misdiagnosed for 7 months.

Answer
The following is an excerpt from a 2008 Emedicine article by Sherman and Gotlin entitled "Sacroiliac Joint Injury":

"Many risk factors are associated with lower back pain, and many are directly associated with lumbar disk injury. These include, but are not limited to, smoking, poor physical condition, positive family history, and occupational lifting.

Factors that specifically increase the likelihood of mechanical injury to the SIJ have not been identified. Pregnancy is one particular condition attributed to SIJ dysfunction.

In the authors?experience, certain biomechanical or muscle length imbalances may ultimately predispose a person to sacroiliac dysfunction and pain. Likely, this is a result of altered gait patterns and repetitive stress to the SIJ and related structures. These conditions exist in persons with leg-length inequality, scoliosis, a history of polio, poor-quality footwear, and hip osteoarthritis."

Healing time is variable, and no definite time frame has been cited in the literature.

In addition to corticosteroid injections, you may also benefit from ultrasound therapy or interferential current to help heal the affected tissues and reduce inflammation in the joint and related tissues.

Massage therapy and acupuncture may also be helpful.

With regard to manipulation, I would recommend only a table-assisted drop technique, which differs from the side-posture manipulation you received in that the patient is treated in the prone position and the pelvic piece of the table is cocked under light tension; a very gentle downward thrust is applied, and gravity is utilized as the main force to move the joint.

Also, pelvic blocking may also be used by a chiropractor (sometimes called sacro-occipital technique, or SOT) with no thrust applied to the SI joint.

Massage therapists, chiropractors, or osteopaths who practice manipulation also may use a gentle technique called cranial-sacral therapy; the proposed mechanisms of both SOT and cranial-sacral therapy have not been conclusively proven, but the techniques themselves are gentle and may be helpful, as they involve light contacts rather than thrust-type manipulation.

I hope you find this information helpful.